Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis

Abstract

Magnetic resonance (MR) scanning has become an important diagnostic and management tool in cryptococcal meningitis (CM). However, there are only isolated case reports documenting neuroradiological findings in human immunodeficiency virus (HIV)-negative patients with CM and none has clearly addressed the relationship between cerebral lesions on magnetic resonance imaging (MRI) and prognosis. The MR brain images available from 114 HIV-negative patients with CM were retrospectively analysed. Patients were divided into Group I with one or more CM-related lesions and Group II without CM-related lesions. Initial clinical and biochemical markers and prognosis were collected and compared between the two groups. In the present study, the most common pattern of CM-related lesions by MRI was radiological meningitis, following by Virchow-Robin (VR) dilatation, hydrocephalus, intracerebral nodules and pseudocysts, which was different from previous studies reporting that the main MR findings of cerebral cryptococcosis in HIV-infected patients include dilated VR spaces, masses and pseudocysts. Compared to the patients without CM-related lesions, patients with CM-related lesions presented with a higher percentage of male patients, a higher frequency of altered mental status, a higher positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) and a lower ratio of CSF glucose/blood glucose. Poor outcomes were more frequent in patients with presence of CM-related lesions compared to patients without CM-related lesions. In conclusion, the main pattern of cryptococcosis-related lesions on MR scanning differ between non-HIV- and HIV-positive patients with CM. The presence of CM-related lesions was significantly associated with predictors for poor outcome. Neuroimaging on MR scanning is a useful tool to evaluate the initial severity and prognosis of CM without HIV infection.

Choroid Plexitis and Ependymitis by Magnetic Resonance Imaging are Biomarkers of Neuronal Damage and Inflammation in HIV-negative Cryptococcal Meningoencephalitis

“…Assessing responsiveness to immunosuppressive agents including corticosteroids 6 creates a need for readily available clinical biomarkers of inflammation and neuronal damage that can be used in combination with microbiological biomarkers, such as early fungicidal activity 7 , 8 , to individualize and guide therapy. The imaging findings of CM have been described in HIV+ 9 – 15 , and HIV− patients 16 – 23 , including meningitis, meningoencephalitis, hydrocephalus, isolated cryptococcomas and disseminated cryptococcosis. Additional findings in HIV− subjects include choroid plexitis and ependymitis as well as pachymeningeal enhancement and ischemic infarcts 18 , 22 , 24 – 26 .…”

Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis

“…Previous reports examining neuroradiological findings in HIV-negative patients with CM refer little to WMLs (4-6); however, a recent study using diffusion tensor imaging has revealed marked white matter structural damage in HIV-negative patients with CM, which was associated with an increased CSF cryptococcal antigen titer (18). The prevalence of WMLs in HIV-negative patients with CM was more frequent than that previously reported despite the small number of patients included in our study.…”

“…In HIV-negative patients with CM, brain magnetic resonance imaging (MRI) often reveals dilated Virchow-Robin spaces, hydrocephalus, intracerebral nodules and pseudocysts, cortical and lacunar infarcts and gadolinium-enhanced leptomeningeal lesions (4-6). In addition, white matter lesions (WMLs) have been reported in a few patients (7,8); however, little is known about the pathogenic mechanisms of the lesions.…”

Cryptococcus Meningitis Can Co-occur with Anti-NMDA Receptor Encephalitis

“…A previous report concerning the CT and MRI findings in 29 HIV patients with CM revealed cryptococcoma (mass lesions), dilated Virchow-Robin spaces (VRS), miliary enhancing nodules in the parenchyma and leptomeningeal-cisternal spaces, along with a mixed pattern ( 5 ). Another study in 114 non-HIV CM patients showed that initial MRI was most commonly characterized by radiological meningitis, followed by VRS dilation, hydrocephalus, masses, and pseudocysts/cryptococcomas ( 6 ). Bilateral hippocampal damage is uncommon in patients with CM.…”